Are you ready to get EnergySmart Long Island? Complete and submit this simple form and you're on your way to lower energy bills!

* = Required Field

Contact Information
*Name: (First, MI, Last)	Mr.   Ms.   Mrs.
*Address: (City, State, ZIP)	AL AK AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NY NV OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY
*Phone:	() -
Alternate Phone:	() -
*Email:
*Best Time To Call:	Click to choose a time 7:00 am 8:00 am 9:00 am 10:00 am 11:00 am 12:00 pm 1:00 pm 2:00 pm 3:00 pm 4:00 pm 5:00 pm 6:00 pm 7:00 pm 8:00 pm [ or, please respond via e-mail. ]
Household Information
Home Style:	Click to choose Cape Ranch Colonial Split Contemporary Post Modern Traditional Historical Other
Other:
What is the primary heating fuel?	Click to choose Oil Natural Gas Propane Electricity Wood Other
Other:
Your Oilheat Supplier:
Other:
Approximate square footage of living space?
Number of bedrooms:
Do you have a finished basement?	Yes   No
When was the house built?
When did you purchase the house?
What kind of heat do you have?	Click to choose Forced hot air Baseboard radiators Steam radiators Radiant
Other:
Central air conditioning?	Yes   No
Have you made major construction changes in the house?	Yes   No
Have you installed new windows?	Yes   No
Have you added insulation?	Yes   No
Have you switched to more energy efficient bulbs for lighting?	Yes   No
Have you upgraded the heating system?	Yes   No
Is the house drafty?	Yes   No
Are there cold spots?	Yes   No
Are there hot spots?	Yes   No
Do you have high fuel costs?	Yes   No
In order to complete your enrollment we need your digitial signature and address below: I hereby authorize LI Clearing House / Energy Smart LI to obtain my utility billing information from my Heating Oil or Propane Provider and/or National Grid and LIPA. For the property located at .
Please correctly type in the following phrase to verify:
Please type e.n.e.r.g.y. without the periods in the box to the right.